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Violent Crime and Social Worker SafetyBy Sherry Saturno, LCSW, DCSW

On January 19 in White Plains, NY, 26-year-old Jamile Wilson stabbed St. Vincent’s Hospital-Westchester case manager Frances Mortenson, 47, during a home visit. Mortenson suffered multiple stab wounds to her face and the back of her head, neck, and abdomen; she was in critical condition before undergoing surgery. Wilson has since been charged with second-degree attempted murder and criminal possession of a weapon, which are both felonies.

In the article “The Urgency of Social Worker Safety,” National Association of Social Workers (NASW) President James J. Kelly, PhD, ACSW, LCSW, noted, “In the past few years alone, we have witnessed the fatal stabbing of a clinical social worker in Boston, the deadly beating of a social service aide in Kentucky, the sexual assault and murder of a social worker in West Virginia, the shooting of a clinical social worker and Navy Commander at a mental health clinic in Baghdad, and the brutal slaying of social worker Teri Zenner in Kansas These are only a few of the murders of our colleagues, which, along with numerous assaults and threats of violence, paint a troubling picture for the profession.”

Violence against social workers has become an inherent risk of the profession and undeniably one that needs to be addressed on a national scope. Social workers are frequently sent alone and unarmed to dangerous situations in neighborhoods that police do not enter without a partner and a gun. Social workers stage life-changing interventions daily, but what measures are being taken to ensure their safety? What if, as the husband of deceased social worker Teri Zenner questioned, national legislation was passed making attacks on social workers an automatic felony?

Elizabeth Hoffler, special assistant to the NASW executive director, says, “According to the NASW Code of Ethics, social workers ‘should be aware of the impact of the political arena on practice and should advocate for changes in policy and legislation to improve social conditions in order to meet basic human needs and promote social justice.’ This standard applies to social work safety, which should be the foundation for successful social work practice. Just as we would advocate for policy and legislation that affects our clients, we should also be our own best advocates and support organizational policy and state and federal legislation that will create a safe environment where social workers can best serve their clients.

“At the federal level, NASW has supported the Teri Zenner Social Worker Safety Act, and numerous NASW chapters have worked to introduce and pass legislation that would address these issues at a local level,” Hoffler continues. “Without systematic change at a macro level, social work safety will continue to be part of public discourse and concern only after a social worker has been harmed or killed.”

Zenner, 26, a social worker in Kansas, was murdered during a home visit by a client who attacked her with a knife and a chainsaw. The Teri Zenner Social Worker Safety Act, if enacted nationally, would award grants to states to provide safety measures to social workers in the form of safety equipment, trainings, facility safety improvements, and educational resources.
“We’re often working with clients at their most vulnerable or emotional time, when they’re dealing with a mental health crisis, with issues of poverty, with child welfare concerns, things that are very serious. The social worker is coming in to help the situation, but it’s not always viewed that way,” Hoffler explains.

Eric Neblung, PhD, president of the New York State Psychological Association forensic division, addresses pervasive matters that social workers and mental health therapists face when interacting with potentially violent clients. “While we are at an increased risk for workplace violence than the general public, it is important to remember that the vast majority of persons with mental health concerns are not violent. In fact, they are more likely to be victims of violence than the perpetrators of it,” he says.

“At this stage in the literature, there is no clear profile of who gets attacked,” he continues. “In other words, we are all at risk, so do not let your professional guard down. Steps that can be taken include [the following]: Watch for antecedent behaviors such as verbal threats; maintain clear boundaries and addressing boundary violations as they arise; if you can avoid it, do not work alone; if you have concerns about a client, seek peer consultation or supervision; maintain an unlisted telephone number and home address; and seek assistance from the legal system if warranted, e.g., order of protection, etc.”

What formal safety measures are imperative for social workers in the field? In February, the NASW offered a webinar on client violence and social worker safety. Presented by Christina Newhill, PhD, ACSW, the webinar discussed a client violence study survey in which Newhill had obtained 1,129 social worker respondents. Fifty-eight percent of the respondents had directly experienced an incident of client violence, and more than 63% were aware of colleagues who had experienced client violence.

Conducting a thorough clinical risk assessment of every client is critical, as is determining a prior history of violence, drug/alcohol use, and weapon use. In terms of preventing of violence, knowledge is power. Individual risk factors that should be explored include demographic, clinical, and biological ones.

Additionally, proactive steps such as detailed safety trainings for social workers who make home visits, instilling a culture of safety and risk reduction within agencies, utilizing technology such as GPS tracking and cell phones for social workers in the community, and crisis management and self-defense instruction will promote safety. Acts as basic as eliminating objects that may be thrown or used as weapons in office settings can make a difference. Safety precautions and the analogous plans should be as automatic for an agency as planning a fire drill. Agencies should establish a worker safety manual and a corresponding committee to address issues and revisit salient concerns.

The NASW Massachusetts Chapter’s Committee for the Study and Prevention of Violence Against Social Workers has created a general outline to safeguard against potential violence. The safety plan of action concentrates on recognizing signs of client agitation, formulating code words to signal for help secretly, de-escalation attempts, disengagement skills, and self-defense. Social workers should always remain close to an exit and if they feel threatened by a client, they should trust their instincts and leave. Legal repercussions of violent behavior should be made known to clients. In 2004, the NASW, in tandem with the Center for Health Workforce Studies of the University at Albany, conducted a national study of 10,000 licensed social workers in which 44% of the respondents revealed that they had been confronted with personal safety issues on the job, underscoring the gravity of this threat.

“One of the biggest steps is increased awareness and communication by professional organizations such as the NASW,” says Neublung. “Getting the word out is key. What is lacking is a formalized approach from training programs. Several authors have called for increased training in risk reduction and workplace violence yet few training programs across mental health disciplines provide this service.”

There is no one solution to prevent violence against social workers. Through legislation, advocacy, grants, trainings, and public recognition of danger, assumption of risk by social workers in the field may be diminished.

— Sherry Saturno, LCSW, DCSW, is clinical director of the Behavioral Health Center at Westchester Medical Center and was awarded Social Worker of the Year in 2010 by the National Association of Social Workers New York State-Westchester Chapter.